Provider Demographics
NPI:1235102120
Name:BALDERSTON, ROSEMARY (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BALDERSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1024 BATTLEFIELD BLVD S
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4215
Practice Address - Country:US
Practice Address - Phone:757-410-4488
Practice Address - Fax:757-410-4450
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherMID ATLANTIC SOLUTIONS
VA30107OtherSENTARA/OPTIMA
VA541595397OtherVIRGINIA HEALTH NETWORK
VA005643767Medicaid
VA454283OtherANTHEM
VA541595397OtherCIGNA
VA7720440OtherAETNA
VA541595397OtherTRICARE
VA454283OtherANTHEM
VAF97946Medicare UPIN